The human brain works hard every second of the day. It controls memory, movement, breathing, emotions, and sleep. Like any busy machine, the brain creates waste as it works. Scientists now know that one of the brain's most important cleaning systems uses a clear liquid called cerebrospinal fluid, or CSF. CSF surrounds the brain and spinal cord. For many years, researchers believed it mainly acted like a cushion to protect the brain from injury. Today, scientists understand that CSF also plays a major role in removing harmful waste and toxic proteins from the brain. This cleaning system is very important because toxic proteins are linked to diseases such as Alzheimer's, Lewy body, and Parkinson's Dementia diseases (PDD). What Is Cerebrospinal Fluid? Cerebrospinal fluid is a clear, watery liquid made inside spaces in the brain called ventricles. Adults usually have about five ounces of CSF in their bodies at one time. CSF has several important jobs: Protecting the brain and spinal cord from injury Delivering nutrients to brain cells Removing waste products Helping maintain healthy pressure inside the skull Scientists sometimes compare CSF to a river that flows through and around the brain. The Brain's Cleaning System In the last 15 years, researchers have discovered a specialized waste-removal system called the glymphatic system. This system uses CSF to help wash away waste from brain tissue. During this process, CSF flows along blood vessels deep into the brain. The fluid mixes with another liquid called interstitial fluid, which surrounds brain cells. Together, these fluids carry away waste products and toxic proteins. Some of the harmful proteins removed by the glymphatic system include: Beta-amyloid, linked to Alzheimer's disease Tau proteins linked to Chronic Traumatic Encephalopathy Alpha-synuclein, linked to Lewy body disease When these proteins build up in the brain, they can damage nerve cells and affect memory and thinking. Sleep Helps the Brain Clean Itself One of the most important factors for healthy brain clearance is sleep. Researchers at the University of Rochester found that the glymphatic system becomes much more active during sleep. In fact, the brain clears waste much faster while a person sleeps than while awake. Scientists believe this happens because brain cells shrink slightly during sleep. This creates more space for CSF to flow through brain tissue and remove waste. Poor sleep may slow brain cleaning and allow toxic proteins to build up over time. Studies have shown that people who regularly get too little sleep may have higher levels of beta-amyloid in the brain. Blood Flow and Heart Health Matter Healthy blood flow also helps CSF move through the brain. The movement of CSF partly depends on the pulsing of blood vessels. Every heartbeat helps push fluid through the glymphatic system. Problems that affect heart and blood vessel health can reduce brain clearance. These problems include: High blood pressure Diabetes Obesity Smoking Hardening of the arteries, sometimes called atherosclerosis. Researchers have found that people with poor cardiovascular health often have reduced waste removal in the brain. Exercise may help improve brain clearance by supporting healthy blood flow. Aging Slows Brain Clearance As people age, the brain's cleaning system becomes less efficient. Animal studies show that older brains often have slower CSF flow and reduced glymphatic activity. Scientists believe this may be one reason why Dementia risk increases with age. One important protein involved in brain clearance is called aquaporin-4. This protein helps control the movement of water through brain tissue. In healthy younger brains, aquaporin-4 is organized around blood vessels. In aging brains, this organization becomes less effective, making waste removal harder. Researchers are studying whether improving aquaporin-4 function could someday help treat or prevent neurodegenerative diseases. Body Position During Sleep Even sleeping position may affect brain clearance. Some animal studies suggest that sleeping on one's side may allow better CSF flow compared with sleeping flat on the back or stomach. Scientists are still learning how body position affects human brain clearance, but the findings are interesting. Looking Ahead Researchers are working hard to better understand the brain's cleaning system. Many experts believe that improving CSF flow and glymphatic function could become an important part of preventing diseases like Alzheimer's. Although scientists still have much to learn, several habits may support healthy brain clearance: Getting enough sleep Exercising regularly Managing blood pressure and diabetes Avoiding smoking Eating a healthy diet The discovery of the glymphatic system has changed how scientists think about brain health. It also offers hope that future treatments may help the brain remove harmful proteins before serious damage occurs. Sources Xie L, et al. Sleep drives metabolite clearance from the adult brain. Science. 2013;342(6156):373-377. Iliff JJ et al. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid beta. Science Translational Medicine. 2012;4(147):147ra111. Nedergaard M, Goldman SA. Glymphatic failure as a final common pathway to dementia. Science. 2020;370(6512):50-56. Mestre H, et al. The brain's glymphatic system: current controversies. Trends in Neurosciences. 2020;43(7):458-466. Jessen NA, et al. The glymphatic system: a beginner's guide. Neurochemical Research. 2015;40(12):2583-2599. Benveniste H, et al. The glymphatic system and waste clearance with brain aging: a review. Gerontology. 2019;65(2):106-119. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Click here for Spanish Click here for French Video Transcript [Answer 1030] Welcome and thank you for joining me. Today we're going to talk about how hoarding can be reconsidered in persons living with Dementia. Hoarding means collecting or keeping too many items, sometimes to the point where it makes a space crowded or unsafe for people living with Dementia. This behavior can happen for many reasons, and it is important to understand it with patience and compassion. Sometimes hoarding is linked to memory loss. A person may forget they already have something and keep collecting more. At other times, the items may bring comfort or a sense of control, especially when other parts of life feel confusing or beyond their control. Holding on to things may also be a way of staying connected to memories or to people they love. Instead of seeing hoarding only as a problem, it helps to consider why it might be happening. This shift in thinking allows caregivers to respond with kindness rather than frustration. For example, if someone collects newspapers, perhaps it gives them comfort to read or hold on to the information. If they keep food items, it may be because they fear running out. Addressing hoarding in Dementia begins with safety. Clearing walking paths, removing spoiled food, and reducing fire hazards are most important. At the same time, try not to take away all belongings suddenly, as this can cause distress. A better way is to slowly guide the person to keep a smaller number of items while gently removing what is unsafe. Offering alternatives, like a memory box with special objects or photographs, can also help with patience, respect, and creativity. Families can balance safety while honoring the person's feelings. On behalf of the Dementia Society of America®, thank you again for joining me today. Stay informed, stay healthy, and take care of yourself. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Vascular Dementia may account for 12 to 20 percent of all Dementias and is the second most common age-related Dementia. Unlike the gradual progression of Alzheimer's disease, the onset of Vascular Dementia symptoms is often abrupt and occurs when a heart attack or a stroke dramatically reduces blood flow to or through the brain. Hallucinations, rather than the memory loss associated with early-stage Alzheimer's disease, are another indicator of Vascular Dementia. Vascular Dementia can also have a slow progression. This happens when the cumulative damage of transient ischemic attacks – often called TIAs – causes many small areas of brain damage and, eventually, noticeable symptoms. The descriptive term "multi-infarct Dementia" is used by healthcare providers to describe this type of Vascular Dementia. Infarcts refer to the many (multiple) areas of non-functioning brain tissue that accumulate over time. Multi-infarct Dementia is the most common type of Vascular Dementia. Depending on the location within the brain, multi-infarct Dementia produces a spectrum of physical, behavioral, and emotional changes. An example of a physical change is shuffling or walking with small, rapid steps. Behavioral symptoms can include slurred speech, getting lost in familiar surroundings, and difficulty in following instructions. Sometimes people cry or laugh at inappropriate times. As you can now appreciate, telling the difference between Alzheimer's disease and Vascular Dementia can be difficult. If the changes appear rapidly, Vascular Dementia, resulting from a stroke or heart attack, is the likely culprit. To make things even more complicated, many people have both Alzheimer's disease and Vascular Dementia. Reducing the Risk of Vascular Dementia There are several ways you can reduce the risk of Vascular Dementia. Some of these include: maintaining healthy blood pressure; eating a healthy diet; maintaining a healthy weight; exercising regularly; and refraining from or quitting smoking. It is worth noting that all of these modifiable conditions and behaviors affect the cardiovascular system and blood flow to the brain. References: Vascular cognitive impairment and vascular Dementia. Mayo Clinic. Updated 2026. Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the Author of "An Unintended Journey: A Caregiver's Guide to Dementia", available through Amazon. Please visit our Author's page to learn more and find this title. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Lewy Body Dementia (named after Frederich Heinrich Lewy, who in 1912 described the disease) is a spectrum disorder described by a rapid decline in the patient's cognition and behavior. Hallucinations and delusions, as well as alterations in sleep, heart rate, and digestion, are other characteristics of Dementia with Lewy bodies. Certain subtypes of Dementia with Lewy Bodies cause people to experience shaking, rigidity, and balance difficulties. The presence of Lewy bodies – abnormal brain deposits composed of several proteins located throughout the brain- is the post-mortem diagnostic hallmark. Dementia with Lewy bodies is a rapidly progressing disease. Death usually occurs within five to seven years of diagnosis. Symptoms of Lewy Body Dementia Unlike Alzheimer's Disease, Dementia with Lewy bodies does not have predictable stages. Early symptoms of the disease vary. Some people first experience cognitive and memory changes similar to those associated with early Alzheimer's Disease. For other people, the first symptoms may include shaking and a shuffling gait. Sometimes hallucinations are the first symptom. Therefore, a thorough medical exam plays an important role in ruling out other causes such as Parkinson's Disease or the side effects of medications used to treat other illnesses and conditions. Responses to the medications used to treat or reduce the severity of hallucinations can inadvertently confirm a diagnosis of Dementia with Lewy bodies. Unlike people who have Alzheimer's Disease, people who have symptoms commonly associated with Dementia with Lewy bodies can have dangerous, and sometimes fatal, reactions to antipsychotic medications such as haloperidol (Haldol) and risperidone (Risperdal). (See Reference 1 below.) This finding underscores the importance of maintaining detailed medical history notes and prescription records. This is especially true for first-time appointments and for emergency room visits. Lewy bodies are also found in other brain disorders such as Parkinson's Disease. Many people who have Parkinson's Disease eventually develop the thinking and reasoning difficulties associated with Dementia with Lewy bodies. Conversely, many people who have Dementia with Lewy bodies experience the shaking and shuffling gait associated with Parkinson's Disease. The overlap in symptoms and other evidence suggest that Dementia with Lewy bodies, Parkinson's Disease, and Parkinson's Disease Dementia may share underlying abnormalities. Reference: "What are the treatment options for Lewy body Dementia?" Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the Author of "An Unintended Journey: A Caregiver's Guide to Dementia", available through Amazon. Please visit our Author's page to learn more and find this title. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

The recent revelation that actor Bruce Willis is living with Frontotemporal Dementia (FTD) is a reason to highlight this past post. In 1892, the German neurologist and psychiatrist Arnold Pick described a case involving an elderly patient with progressive loss of speech and Dementia. Later, when the patient died, the autopsy showed that specific brain parts had shriveled. Unlike the overall shrinkage associated with Alzheimer's Disease, this type of Dementia appeared to target the frontal and temporal lobes. The two frontal lobes, located at the front of each hemisphere, contain the structures that control our executive functions, such as planning, organizing, and problem-solving. The frontal lobes also control behavior, emotions, and personality. The two temporal lobes, located on each side of the brain just above the ear, allow us to perceive and recognize faces and objects and transfer short-term memories into our long-term memory banks. Symptoms of Frontotemporal Dementia It is not surprising to discover that people living with Frontotemporal Dementia (FTD) may no longer seem like the people we once knew. A parent who was once friendly, polite, and careful about their appearance may say and do socially unacceptable things. Emotional blunting, or the inability to express verbal and non-verbal feelings, is another characteristic of this type of Dementia. Another indicator of FTD is difficulty in using and understanding spoken and written language. Language difficulties include repeated mispronunciations and the inability to make appropriate associations between objects and their name. Patients with frontotemporal lobe disease may use words and phrases such as “this,” “that,” and “over there” in place of specific nouns and descriptions. People who have Frontotemporal Dementia are not aware of how they have changed. Scientists do not know the cause of Frontotemporal Dementia. However, research demonstrates that genetics often plays a role in its development. Some studies show genetic alterations in genes that encode specific brain proteins in nearly 45 percent of people with family members who have certain types of Frontotemporal Dementia.1 These altered proteins form insoluble deposits in brain neurons. Protein deposition causes neurons to swell, burst, and die.2 It appears that genes play a role in nearly 45 percent of people who have Frontotemporal Dementia. However, it is also important to remember that for more than 50 percent of Frontotemporal Dementia families, genetics either does not play a role or is not yet an understood factor. Tests are available to determine if the Frontotemporal Dementia that you, or another family member, have is genetic. Deciding to undergo testing is not always easy. It is essential to consider how you and other family members might feel if you should receive positive results. Will knowing make you anxious, relieved, or empowered? Will other family members also want to test? How might this information affect family planning for you or your adult children? Will having a positive test influence your employer or make it more difficult to receive health or life insurance? Anybody would find these and many other questions challenging to answer. Often, people find talking with a genetic counselor can make the decision to test – or not – easier. The genetic counselor, by explaining the technical and emotional aspects of genetic testing, can help you make a comfortable decision. Afterward, the genetic counselor can explain the test results to you and guide discussion about any further steps you may want to take. References: 1. HS Kirshner, “Frontotemporal lobe dementia: Genetic Distribution and Variation.” Accessed 2026. 2. W Leonard, MPH, “Causes of Dementia” (Updated 2025). Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of "An Unintended Journey: A Caregiver's Guide to Dementia.", available through Amazon. Please visit our Author's page to learn more and find this title. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Have you ever taken a cruise, or even thought about doing so? Getting aboard a cruise ship for the first time and not knowing what is coming next might create a bit of fear. Fear that may have kept you from booking the trip for months, and maybe from doing it at all. Not being able to “see land,” or the destination, can sometimes lead to anxiety. But turn that understanding around; once experienced, you may not be able to imagine a life without the joy of meeting new people and exploring new cultures. But even well-worn ship captains use tools on every voyage to safely navigate and make steady progress: a map and a compass. Not knowing what's coming next can be frustrating and even disastrous, but with guidance and the right information, there can be a steady calm in the midst of the stormiest weather. Dementia, like cancer, is a term often fraught with an enormous amount of fear and anger stemming in large part from a shortage of information, or sometimes, too much. It's not uncommon for someone who has lived with a chronic and/or life-threatening illness, or who has acted as a caregiver, upon hearing the topic of a specific disease feels so much pain that they do not wish to revisit the experience in any way, shape, or form. Repeated exposure may help dampen the immediate response, but deep down, without the ability to process unpleasant feelings and without the right tools, it can remain painful for some time. Having a Compass Can Help In the case of Dementia, knowing is hard, but good. It's hard because we basically understand what it is: a gradual loss of cognitive abilities. But it's also valuable because the act of "knowing more" can relieve at least some of the anxiety. Having a map and a compass allows you to plan your actions and enhance your responses as you cross the sea of life. Without a doubt, if you believe you or a loved one or friend is experiencing one or more cognitive challenges, it is imperative to sort through what's going on and begin to understand the possible causes, progression (if, in fact, it's Dementia), care, or interventions that make the most sense given whatever you learn. Neurologists (brain specialists), and particularly those who specialize in Dementia, are the current "Ship Captains" for a full cognitive workup. That's not to say that primary care physicians don't play an important role; they do. Even trained social workers, nurses, psychologists, psychiatrists, and many other healthcare professionals can help identify issues that need further insight and testing. Don't walk out of an annual check-up and say "everything's okay," if you know in your heart-of-hearts it isn't, or if others you respect and love say that there's something "still going on." Dig deeper. Get a check-up from the neck-up, as Zig Ziglar used to say. Having a "neuropsych" examination, along with blood tests, a nutritional evaluation, and maybe even certain scans or more advanced tests, is often the right course of action. Eliminate all possible causes, even reversible forms, of cognitive difficulty and, as with most major health issues, seek second opinions as necessary. Over the next four months, we're going to explore in greater depth the following leading forms of Dementia: Alzheimer's Disease, Vascular Dementia, Lewy Body Dementia, and Frontotemporal Dementia. Then we will follow with lesser-known types of Dementia which may result from traumatic brain injury (TBI), repetitive concussions (CTE), infections/viruses (CJD and HIV), alcoholism, and others. Knowledge is like a compass rose, always pointing north; it can guide, empower, and reduce anxiety. Like a ship setting sail to a new port of call, with a good map and a reliable compass, having "knowledge" tools enables you to chart a course towards your best possible tomorrow. Author: Kevin Jameson, Volunteer | President | Chairman. Dementia Society of America. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

"We need to make it right before it goes wrong." What a wonderful expression! The phrase gives you permission to say, "I need your help." Yes, it is true that some people, even without your asking, will be more than happy to volunteer their time. However, an uncommitted "Call if you need anything" is not the same as "What do you need? Tell me what I can do to help you." Many family and friends, perhaps not understanding the responsibilities and challenges you face, will require a little prodding. A good approach is to organize an informal gathering with your family and perhaps a few friends. Lunch or light refreshments may prevent the conversation from becoming confrontational. Use video conferencing to include and get input from family members who do not live nearby. Give examples of what they can do for you and for the loved one you have in common. A request for respite – just a few hours per week – is a good place to start. Explain you need time to relax, to take care of your health and well-being, to socialize with friends, to enjoy a little solitude as well as time to catch up on lost sleep. Getting Support for Caregiving While you will appreciate their gift of time, there are many other ways your family can make things easier for you. A sibling who does not live nearby can manage your loved one’s finances. Family, friends, and even nearby neighbors can buy groceries, do the laundry, or take responsibility for things like a car, a house, or yard maintenance. Ask that a family member or a friend accompany you and your loved one to doctor appointments or other places where you anticipate having behavioral difficulties. A promise to go out to lunch after their doctor's appointment can improve everyone's mood. Use a calendar and sign-up sheet to free yourself from day-to-day management details. Exchange contact information to make communication as easy as possible. Consider designating a point of contact. Think about using an online app or website like www.lotsahelpinghands.com. A few words to caregivers – don't be stoic. Accept help! Promises aside, it's more important to be a good caregiver than an irritable, exhausted, and burnt-out one. A few words to family members – don't assume one person can shoulder all the responsibilities and challenges of caring for the loved one you have in common. It's unfair and will create ill feelings. Make yourself available even if he or she claims they neither need nor want your assistance. It's also important that you tell your family member that you appreciate his or her efforts – a gift certificate to a favorite restaurant or for a rejuvenating massage is another way to express your gratitude. Call or e-mail often - but not too often or at inconvenient times. In addition to inquiring about your loved one, be sure to ask your family member about their general well-being. Be an empathetic and supportive listener. And to caregivers, family members, and friends - the most important words you can say to one another are "Thank you." Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the Author of "An Unintended Journey: A Caregiver's Guide to Dementia", available through Amazon. Please visit our Author's page to learn more and find this title. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Click here for Spanish Click here for French Video Transcript [Answer 1012] Welcome and thank you for joining me. Today, we're going to talk about how to address conflict among family caregivers of someone living with Dementia. Caring for a loved one with Dementia can be rewarding, but it can also bring stress. When several family members are involved, disagreements can happen. These family conflicts are common, and there are ways to handle them with respect and understanding. To begin with, remember that everyone cares about the person living with Dementia, but each family member may see things differently. One person might think more about medical needs while another focuses on comfort or daily routines. These different viewpoints can lead to arguments if people do not take time to listen. Open and calm communication is key. Try to set aside time to talk when everyone can share their thoughts without interruptions, speak honestly but kindly, and listen to each other. Instead of blaming, use "I" statements, such as "I feel tired when I handle all the appointments," rather than "You never help." Another helpful step is dividing tasks fairly. Sometimes one caregiver carries most of the weight. It helps to make a simple list of jobs like shopping, cooking, bathing, or driving to appointments, and share them in a way that feels balanced. If one person cannot do physical tasks, maybe they can help with finances or phone calls. If disagreements continue, it may be useful to bring in outside help. A social worker, counselor, or support group can help the family find common ground. Sometimes having a neutral person in the room makes it easier for everyone to agree. Above all, always remember the main goal: the comfort and dignity of the person living with Dementia. Working together with patience and respect helps the whole family. On behalf of the Dementia Society of America®, thank you again for joining me today. Stay informed, stay healthy, and take care of yourself. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Click here for Spanish Click here for French Video Transcript [Answer 1148] Welcome, and thank you for joining me. Today, we're going to talk about how to respond when a person living with Dementia thinks you are stealing from them. This accusation of stealing can feel hurtful, but it is a common symptom of Dementia and not a personal attack. Why does this happen? A person may misplace items and not remember where they put them because the brain is trying to make sense of the situation. They may believe someone has taken the item. Fear and confusion can make this feeling very real to them. Stay calm and do not argue. It is important not to argue or try to prove them wrong. Saying "I didn't take it" repeatedly can increase stress and make the person feel more upset. Acknowledge their feelings. Instead, respond to the emotion. You might say, "That sounds upsetting," or, "I can see you're worried." This acknowledgment helps the person feel heard and understood. Offer to help. Look for the item gently. Search in common places where items are often misplaced. Even if you already know where it is, involving them in the search can reduce anxiety. Redirect if needed: If you cannot find the item, gently shift attention to another activity. A walk, a snack, or music can help move the focus away from the worry. Create a safe routine. Keep important items like keys, glasses, or wallets in the same place each day. This habit can reduce confusion and prevent future distress. Protect your own feelings. Remember, this is the Dementia speaking, not the person you know. Try not to take it personally. Responding with patience, reassurance, and kindness helps reduce fear and builds trust. On behalf of the Dementia Society of America®, thank you again for joining me today. Stay informed, stay healthy, and take care of yourself. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Changing the Narrative's 2023 Banner on "Imagine a World Without Ageism" https://changingthenarrativeco.org July 21, 2025 Hello, my name is Dr. Arun Rao, and I serve as an Advisor to the Dementia Society. In June 2025, I presented a workshop on Ageism and Healthcare at the Center for Modern Aging, Princeton's (https://cmaprinceton.org) Inaugural Symposium on Aging. One of the sources I used in preparing for the presentation included this quote, and I think it's a very profound thought. Ageism, which is stereotyping, prejudice, and discrimination based solely on a person's age, affects ALL of us- regardless of skin color, gender, background, social status, sexual orientation, etc. In fact, it can contribute to all those other issues used to discriminate against people. But whether we like it or not, we will likely all face an ageist comment or action in our lives. And the healthcare system is rampant with ageist beliefs. As a geriatrician, one of my goals in life is to look beyond chronological age and respect the individual patient in front of me as one individual person - an older adult with their unique background, history, abilities, and priorities. Soooooooo, let's talk about ageism and how we can hopefully combat it. The basic definition, as I mentioned above, was initially coined by the pioneering geriatrician Dr. Robert Butler in 1969. It is estimated to cost society about $63 BILLION due to its negative impacts on health, healthcare access, & healthcare delivery. There are 3 basic types of ageism: Institutional- these are laws, policies, societal norms, & practices that restrict access and systematically disadvantage people based on their age. The shortage of geriatricians in the United States is due to inadequate reimbursement for doctors specializing in this field. The underrepresentation of older adults in medical & scientific research often means that studies generally do not focus on conditions that become more common as we age. Medical trainees get more exposure to OB/Gyn or pediatrics than to geriatrics, even though most physicians will treat older adults rather than younger ones. Interpersonal- comes up during interactions between people. Providers attributing symptoms & complaints to aging rather than considering the possibility of an underlying disease. Elderspeak- infantilizing, dismissive, & demeaning way we speak to older adults: Making the assumption that you should automatically use a louder voice, slow your speech, & repeat yourself when speaking with an older adult. Yes, it might help, but it can be insulting if not needed Using phrases such as "Honey," "Sweetie," "Dear" Calling older adults "cute" The conversation with the medical professional (e.g., the doctor) ignores the patient in the room and talks with their care partner, rather than including the patient. Self-directed- biases & beliefs that are internalized. These internalized beliefs can be the most damaging. Feeling that cognitive decline and symptoms are inevitable due to age, so why bother saying anything By not speaking up, the person and/or their care partner delays evaluation and possible meaningful interventions How does ageism impact healthcare? My belief is: Reduces longevity Poor quality of life Leads to patients being more likely to describe their health as "poor." Worsens physical illness - missed or delayed diagnoses Slower recovery from an illness or disability Undertreatment or overtreatment Increased ER visits & hospitalizations Patient less likely to seek care out of fear of being belittled/dismissed Depression & anxiety Further cognitive impairment Increased social isolation & loneliness As an example, a study at The Johns Hopkins School of Medicine showed that when given a patient's age alone, medical students were more likely to treat pneumonia "aggressively" in a 10-year-old girl than in an 85-year-old woman. So, how can we combat this issue? We (providers and their patients) should accept aging as a natural process with "pros & cons" and understand what constitutes normal aging vs. abnormal aging. We should also be mindful of our own biases and challenge them. We should recognize the diversity of the population of older adults, in essence, "When you've seen one 85-year-old, you've seen one 85-year-old." We need more opportunities for intergenerational exposure. Such exposure has actually been shown to reduce ageism and ageist beliefs. A great resource is the organization Changing the Narrative- https://changingthenarrativeco.org They have many resources to help you understand how to equip yourself to feel empowered, speak up, and know the facts about ageism and aging. And, of course, if you ever want a physician advocate to help you navigate the healthcare system, look to your local... GERIATRICIAN! Information for this post comes from Laura A. Robbins, an ageism expert and former Program Office for The John A. Hartford Foundation in Generations: Journal of the American Society on Aging, Vol. 39, No. 3, Ageism in America: Reframing the Issues and Impacts (Fall 2015), pp. 17-21. Dr. Arun S. Rao, a fellowship-trained & board-certified geriatrician with over 20 years of experience, is the founder & CEO of Geriatrics Planning & Solutions, Inc., a direct-pay house call service for older adults that provides medical care management and consultations. Dr. Rao is a member of the Advisory Council at the Dementia Society of America. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Dementia is costly, both financially and emotionally. If you or a loved one has been diagnosed with Dementia, you are probably overwhelmed with the prospect of how to financially plan for the future. A trusted partner at a time of need can be a welcome help. One option for managing finances is a pooled special needs trust (SNT). A pooled SNT is administered by a nonprofit organization. The organization makes decisions on how funds from the trust are disbursed on behalf of the trust Beneficiary, makes decisions on who invests the funds, fulfills reporting requirements to government agencies, and stays abreast of changing regulations so that means-tested government benefits (like Medicaid and Supplemental Security Income (SSI)) are not jeopardized. Each Beneficiary's funds are placed in an individual sub-account. The cash assets from all subaccounts are then “pooled” together and invested as a group. Earnings based on the Beneficiary's share of the principal are reinvested into each sub-account. A financial record is maintained for each sub-account, reflecting all activity in the account. Each beneficiary or their advocate has access to the financial information either electronically or by mail. Most pooled trusts offer both First-Party and Third-Party SNTs. A First-Party SNT is established with the Beneficiary's own funds. A Third-Party SNT is funded by a third party for the benefit of the individual with Dementia or a family member with special needs. A pooled special needs trust makes sense for multiple reasons. It allows one to set aside funds that will enhance the Beneficiary's quality of life. The Beneficiary can benefit from trust administration services, including investment and management. All disbursements are for the sole benefit of the Beneficiary. Pooling the funds reduces administrative fees and increases the principal available for investment. A pooled SNT will also protect eligibility for Medicaid and Supplemental Security Income in many instances; however, special planning is required for Beneficiaries over the age of 64 who may need Medicaid Long-term Care benefits. Planning is Key It is strongly recommended that you consult with a Trust and Estates Attorney or Elder Law Attorney who can advise you on how a pooled special needs trust can benefit your situation. When appropriate, an SNT can give you a sense of well-being about your own or your loved one’s financial future while continuing to live life with quality and dignity. Authored by Joanne Marcus, MSW, Executive Director, Commonwealth Community Trust (CCT). CCT is a 501(c)(3) national nonprofit organization that administers affordable and efficient pooled special needs trusts. CCT was founded in 1990 and is managed by a Board of Directors who serve with a caring heart and without compensation. With years of experience, CCT has a proven reputation as a prudent steward and administrator. For more information about CCT, contact Joanne Marcus, MSW, Executive Director, at jmarcus@trustcct.org or 804-740-6930. Visit our website at www.trustCCT.org for access to information and additional resources. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

The health benefits of various foods and diets for improving overall health or reducing the risk of disease are newsworthy. Some articles promote the idea that eating fiber-rich fruits, vegetables, and whole grains helps us maintain a healthy weight and lowers our risk of colon cancer. Others assert that the Mediterranean diet – one that encourages replacing red meat with fish and chicken, saturated fats with olive oil, and refined carbohydrates with whole grains – reduces the risk of heart disease, certain cancers, and diabetes. There are many research studies touting the benefits of red wine on lowering cholesterol blood levels and thereby reducing the risk for heart disease, strokes, cataracts, and colon cancer. Though a controversial area of research, some studies indicate drinking moderate amounts of red wine may slow declines in brain function. With respect to consuming wine and other alcoholic beverages, moderation is the keyword. However, most people are unsure how much constitutes a moderate amount. The Link Between Drinking and Dementia According to the Dietary Guidelines for Americans, a low to moderate alcohol consumption is no more than one drink a day for women and older adults, and two for men. One drink is usually 1 1/2 ounces or 15 grams of alcohol, which equals approximately 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor. (See Note 1 below.) These dietary guidelines refer to the amount consumed on any single day, not the average over several days. In other words: Do not save your daily allocation for a weekend binge. Alcohol-related brain damage (ARBD) conditions that include Wernicke-Korsakoff Syndrome and alcoholic Dementia, are the result of drinking too much alcohol over the course of several years. Though both types of ARBD exhibit Dementia-like symptoms, neither condition is true Dementia. The difference between ARBD and Dementias such as Vascular, Lewy body, or Alzheimer's disease is in the ability to treat or stop the progression of symptoms. Consuming more than the recommended amounts of alcohol does increase the likelihood of developing Alzheimer's disease and Vascular Dementia later in life. However, researchers have yet to establish the numerical relationship between alcohol consumption and risk for Dementia. The reasons are many and include research entirely dependent on reported observations and evaluating the variables that, in combination with alcohol consumption, affect the long-term risk for Dementia. However, one can state with certainty that the more you drink, the greater the likelihood of developing Dementia later in life. High alcohol consumption also increases the risk for stroke, heart and liver disease, and depression – all of which are well-known Dementia risk factors. Note: 1. U.S. Department of Health and Human Services and U.S. Department of Agriculture, 2015. 2025 Dietary Guidelines for Americans. Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the Author of "An Unintended Journey: A Caregiver's Guide to Dementia", available through Amazon. Please visit our Author's page to learn more and find this title. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.